Description
Robert Half Management Resources is seeking an experienced Audit Manager to support one of our healthcare clients for an interim part-time project. This role involves conducting in-depth investigations to detect and prevent healthcare fraud, waste, and abuse, contributing to the integrity of healthcare services. The ideal candidate will leverage specialized tools and methodologies to assess claims and support actionable outcomes.
Responsibilities:
Conduct investigations into potential healthcare fraud, waste, and abuse using specialized software and data analysis tools.
Evaluate healthcare claims, medical records, and associated documentation to uncover irregularities and fraudulent activities.
Prepare detailed case notes, summaries, and evidence to support investigative findings.
Collaborate with cross-functional teams, including legal, clinical, and claims departments, to gather relevant information and insights.
Develop comprehensive reports and recommend actions such as recovery, administrative measures, or legal referrals.
Stay informed about healthcare regulations, coding standards, and fraud-related trends to enhance investigative accuracy.
Participate in training sessions to stay updated on software tools and emerging fraud schemes.
Manage caseloads effectively while adhering to deadlines and maintaining high-quality results.
Ensure compliance with organizational policies and ethical standards throughout the investigative process.
Contribute to the development of audit plans and strategies to proactively identify fraud risks.
Requirements - Proven experience in investigating healthcare fraud, waste, and abuse, preferably within a healthcare payer environment.
Proficiency with Healthcare Fraud Shield software or similar tools for case management and analysis.
Strong analytical skills for interpreting complex datasets and identifying suspicious activities.
Excellent communication skills, both written and verbal, for articulating findings and recommendations.
High level of integrity, attention to detail, and discretion in handling sensitive information.
Ability to work independently in a remote setting while managing multiple cases.
Familiarity with healthcare regulations, coding guidelines, and fraud-related trends.
Preferred certifications include Certified Fraud Examiner, Accredited Health Care Fraud Investigator, Health Care Anti-Fraud Associate, or Certified Coder.
Robert Half is the world's first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
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All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.
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